1280 W Lantana Rd Suite 1
Lantana FL 33462
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 2227
Request Appointment Information
Awards & Recognitions
Medical Malpractice Cases
Medical Board Sanctions
Water quality permitting: From end-of-pipe to operational strategies. - Water research
End-of-pipe permitting is a widely practised approach to control effluent discharges from wastewater treatment plants. However, the effectiveness of the traditional regulation paradigm is being challenged by increasingly complex environmental issues, ever growing public expectations on water quality and pressures to reduce operational costs and greenhouse gas emissions. To minimise overall environmental impacts from urban wastewater treatment, an operational strategy-based permitting approach is proposed and a four-step decision framework is established: 1) define performance indicators to represent stakeholders' interests, 2) optimise operational strategies of urban wastewater systems in accordance to the indicators, 3) screen high performance solutions, and 4) derive permits of operational strategies of the wastewater treatment plant. Results from a case study show that operational cost, variability of wastewater treatment efficiency and environmental risk can be simultaneously reduced by at least 7%, 70% and 78% respectively using an optimal integrated operational strategy compared to the baseline scenario. However, trade-offs exist between the objectives thus highlighting the need of expansion of the prevailing wastewater management paradigm beyond the narrow focus on effluent water quality of wastewater treatment plants. Rather, systems thinking should be embraced by integrated control of all forms of urban wastewater discharges and coordinated regulation of environmental risk and treatment cost effectiveness. It is also demonstrated through the case study that permitting operational strategies could yield more environmentally protective solutions without entailing more cost than the conventional end-of-pipe permitting approach. The proposed four-step permitting framework builds on the latest computational techniques (e.g. integrated modelling, multi-objective optimisation, visual analytics) to efficiently optimise and interactively identify high performance solutions. It could facilitate transparent decision making on water quality management as stakeholders are involved in the entire process and their interests are explicitly evaluated using quantitative metrics and trade-offs considered in the decision making process. We conclude that the operational strategy-based permitting shows promising for regulators and water service providers alike.Copyright Â© 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Environmental Enrichment Mitigates Detrimental Cognitive Effects of Ketogenic Diet in Weanling Rats. - Journal of molecular neuroscience : MN
For decades, the ketogenic diet has been an effective treatment of intractable epilepsy in children. Childhood epilepsy is pharmacoresistant in 25-40Â % of patients taking the current prescribed medications. Chronic seizure activity has been linked to deficits in cognitive function and behavioral problems which negatively affect the learning abilities of the child. Recent studies suggest the ketogenic diet (KD), a high fat with low carbohydrate and protein diet, has adverse effects on cognition in weanling rats. The diet reduces circulating glucose levels to where energy metabolism is converted from glycolysis to burning fat and generating ketone bodies which has been suggested as a highly efficient source of energy for the brain. In contrast, when weanling rats are placed in an enriched environment, they exhibit increased spatial learning, memory, and neurogenesis. Thus, this study was done to determine if weanling rats being administered a KD in an environmental enrichment (EE) would still exhibit the negative cognitive effects of the diet previously observed. The present study suggests that an altered environment is capable of reducing the cognitive deficits in weanling rats administered a KD. Learning was improved with an EE. The effect of diet and environment on anxiety and depression suggests a significant reduction in anxiety with enrichment rearing. Interestingly, circulating energy substrate levels were increased in the EE groups along with brain-derived neurotrophic factor despite the least changes in weight gain. In light of numerous studies using KDs that seemingly have adverse effects on cognition, KD-induced reductions in excitotoxic events would not necessarily eliminate that negative aspect of seizures.
The DoD Joint Pathology Center as a Resource for Researchers. - Military medicine
The Department of Defense's Joint Pathology Center (JPC) is the world's largest collection of human pathology specimens, comprising some 7.4 million accessions. The biorepository, which began during the Civil War as a collection of materials obtained from medical and surgical procedures performed by Army physicians, houses specimens and associated data obtained for diagnostic purposes. It also holds several collections of specimens from military personnel who shared a common, service-related exposure or medical condition. This article, which is excerpted and adapted from the 2012 Institute of Medicine report "Future Uses of the Department of Defense JPC Biorepository,"1 summarizes information on the repository, its past uses, and the future operational issues and challenges that the JPC faces as it develops a concept of operations that will allow it to move forward as a resource for researchers.Reprint & Copyright Â© 2015 Association of Military Surgeons of the U.S.
The Air Force Health Study Data and Specimens as a Resource for Researchers. - Military medicine
The Air Force Health Study (AFHS) is perhaps the most thorough longitudinal examination of both the health of military personnel and the health effects of herbicide exposure ever conducted. Data were collected through comprehensive physical examinations, questionnaires, and other records at six time points over a 20-year period; 2,758 subjects participated in at least one examination cycle. Data collected during physical examinations included indices of health status overall and specific endpoints for each organ system. Questionnaire data included sociodemographic information, marital and fertility history, health habits, recreation activities, toxic substances exposure, and military experience. Biospecimens were collected at each examination cycle; serum was collected at all six examinations while other biospecimens, such as semen and whole blood, were collected at one time. More than 200 clinical laboratory tests and measures were performed, with more than 60 of these measured at all six cycles. The vast amount of electronic data and the more than 91,000 unaliquoted biospecimens contained in the repository offer unique opportunities for new research on understanding determinants of health. The Institute of Medicine is the custodian of the AFHS materials and conducted a pilot research program to facilitate new research using the materials. An expert committee issued requests for proposals, created a Web-based form for submissions, reviewed and evaluated potential research studies, and made data and biospecimens available to qualified researchers. This article summarizes the experience of this initiative.Reprint & Copyright Â© 2015 Association of Military Surgeons of the U.S.
Zygosity Differences in Height and Body Mass Index of Twins From Infancy to Old Age: A Study of the CODATwins Project. - Twin research and human genetics : the official journal of the International Society for Twin Studies
A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m2 in childhood and adolescence and up to 0.2 kg/m2 in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than MZ twins; these percentage differences were largest in middle and late childhood and decreased with age in both sexes. The variance of height was similar in MZ and DZ twins at most ages. In contrast, the variance of BMI was significantly higher in DZ than in MZ twins, particularly in childhood. In conclusion, DZ twins were generally taller and had greater BMI than MZ twins, but the differences decreased with age in both sexes.
Does carbon reduction increase sustainability? A study in wastewater treatment. - Water research
This study investigates the relationships between carbon reduction and sustainability in the context of wastewater treatment, focussing on the impacts of control adjustments, and demonstrates that reducing energy use and/or increasing energy recovery to reduce net energy can be detrimental to sustainability. Factorial sampling is used to derive 315 control options, containing two different control strategies and a range of sludge wastage flow rates and dissolved oxygen setpoints, for evaluation. For each, sustainability indicators including operational costs, net energy and multiple environmental performance measures are calculated. This enables identification of trade-offs between different components of sustainability which must be considered before implementing energy reduction measures. In particular, it is found that the impacts of energy reduction measures on sludge production and nitrogen removal must be considered, as these are worsened in the lowest energy solutions. It also demonstrates that a sufficiently large range of indicators need to be assessed to capture trade-offs present within the environmental component of sustainability. This is because no solutions provided a move towards sustainability with respect to every indicator. Lastly, it is highlighted that improving the energy balance (as may be considered an approach to achieving carbon reduction) is not a reliable means of reducing total greenhouse gas emissions.Copyright Â© 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
Gdf5 progenitors give rise to fibrocartilage cells that mineralize via hedgehog signaling to form the zonal enthesis. - Developmental biology
The sequence of events that leads to the formation of a functionally graded enthesis is not clearly defined. The current study demonstrates that clonal expansion of Gdf5 progenitors contributes to linear growth of the enthesis. Prior to mineralization, Col1+ cells in the enthesis appose Col2+ cells of the underlying primary cartilage. At the onset of enthesis mineralization, cells at the base of the enthesis express alkaline phosphatase, Indian hedgehog, and ColX as they mineralize. The mineralization front then extends towards the tendon midsubstance as cells above the front become encapsulated in mineralized fibrocartilage over time. The hedgehog (Hh) pathway regulates this process, as Hh-responsive Gli1+ cells within the developing enthesis mature from unmineralized to mineralized fibrochondrocytes in response to activated signaling. Hh signaling is required for mineralization, as tissue-specific deletion of its obligate transducer Smoothened in the developing tendon and enthesis cells leads to significant reductions in the apposition of mineralized fibrocartilage. Together, these findings provide a spatiotemporal map of events - from expansion of the embryonic progenitor pool to synthesis of the collagen template and finally mineralization of this template - that leads to the formation of the mature zonal enthesis. These results can inform future tendon-to-bone repair strategies to create a mechanically functional enthesis in which tendon collagen fibers are anchored to bone through mineralized fibrocartilage.Copyright Â© 2015 Elsevier Inc. All rights reserved.
Effect of ACL graft material on anterior knee force during simulated in vivo ovine motion applied to the porcine knee: An in vitro examination of force during 2000 cycles. - Journal of orthopaedic research : official publication of the Orthopaedic Research Society
This study determined how anterior cruciate ligament (ACL) reconstruction affected the magnitude and temporal patterns of anterior knee force and internal knee moment during 2000 cycles of simulated gait. Porcine knees were tested using a six degree-of-freedom robot, examining three porcine allograft materials compared with the native ACL. Reconstructions were performed using: (1) bone-patellar tendon-bone allograft (BPTB), (2) reconstructive porcine tissue matrix (RTM), or (3) an RTM-polymer hybrid construct (Hybrid). Forces and moments were measured over the entire gait cycle and contrasted at heel strike, mid stance, toe off, and peak flexion. The Hybrid construct performed the best, as magnitude and temporal changes in both anterior knee force and internal knee moment were not different from the native ACL knee. Conversely, the RTM knees showed greater loss in anterior knee force during 2000 cycles than the native ACL knee at heel strike and toe off, with an average force loss of 46%. BPTB knees performed the least favorably, with significant loss in anterior knee force at all key points and an average force loss of 61%. This is clinically relevant, as increases in post-operative knee laxity are believed to play a role in graft failure and early onset osteoarthritis.Â© 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
An Integrated Environmental Assessment of Green and Gray Infrastructure Strategies for Robust Decision Making. - Environmental science & technology
The robustness of a range of watershed-scale "green" and "gray" drainage strategies in the future is explored through comprehensive modeling of a fully integrated urban wastewater system case. Four socio-economic future scenarios, defined by parameters affecting the environmental performance of the system, are proposed to account for the uncertain variability of conditions in the year 2050. A regret-based approach is applied to assess the relative performance of strategies in multiple impact categories (environmental, economic, and social) as well as to evaluate their robustness across future scenarios. The concept of regret proves useful in identifying performance trade-offs and recognizing states of the world most critical to decisions. The study highlights the robustness of green strategies (particularly rain gardens, resulting in half the regret of most options) over end-of-pipe gray alternatives (surface water separation or sewer and storage rehabilitation), which may be costly (on average, 25% of the total regret of these options) and tend to focus on sewer flooding and CSO alleviation while compromising on downstream system performance (this accounts for around 50% of their total regret). Trade-offs and scenario regrets observed in the analysis suggest that the combination of green and gray strategies may still offer further potential for robustness.
Fifteen Years of Explaining Pain: The Past, Present, and Future. - The journal of pain : official journal of the American Pain Society
The pain field has been advocating for some time for the importance of teaching people how to live well with pain. Perhaps some, and maybe even for many, we might again consider the possibility that we can help people live well without pain. Explaining Pain (EP) refers to a range of educational interventions that aim to change one's understanding of the biological processes that are thought to underpin pain as a mechanism to reduce pain itself. It draws on educational psychology, in particular conceptual change strategies, to help patients understand current thought in pain biology. The core objective of the EP approach to treatment is to shift one's conceptualization of pain from that of a marker of tissue damage or disease to that of a marker of the perceived need to protect body tissue. Here, we describe the historical context and beginnings of EP, suggesting that it is a pragmatic application of the biopsychosocial model of pain, but differentiating it from cognitive behavioral therapy and educational components of early multidisciplinary pain management programs. We attempt to address common misconceptions of EP that have emerged over the last 15 years, highlighting that EP is not behavioral or cognitive advice, nor does it deny the potential contribution of peripheral nociceptive signals to pain. We contend that EP is grounded in strong theoretical frameworks, that its targeted effects are biologically plausible, and that available behavioral evidence is supportive. We update available meta-analyses with results of a systematic review of recent contributions to the field and propose future directions by which we might enhance the effects of EP as part of multimodal pain rehabilitation. Perspective: EP is a range of educational interventions. EP is grounded in conceptual change and instructional design theory. It increases knowledge of pain-related biology, decreases catastrophizing, and imparts short-term reductions in pain and disability. It presents the biological information that justifies a biopsychosocial approach to rehabilitation.Copyright Â© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
Map & Directions
1280 W Lantana Rd Suite 1 Lantana, FL 33462
5301 S Congress Ave
5401 S Congress Ave #102
5401 S Congress Ave Ste 204
5301 S Congress Ave